Patient Experience. Oncological Facilities

Transcription

1 Patient Experience in Oncological Facilities

2 University of Nairobi College of Architecture and Engineering School of The Built Environment Department of Architecture and Building Science BAR 613: Written Thesis Author: Njoroge Godwin Macharia Registration: B Subject: Final Year Thesis Presentation Supervisor: Arch. Kigara Kamweru 2015 I

3 ...Nothing in this life will call upon us to be more courageous, than accepting the fact that it ends... _ANONYMOUS_ II

4 Declaration This Thesis is my original work and has not been presented in any other University or Institution for the purpose of awarding a degree to the best of my knowledge. This thesis is submitted in partial fulfilment of the examination requirements for the award of the Bachelor of Architecture degree, in the Department of Architecture and Building Science at the University of Nairobi. Author: Njoroge Godwin Macharia Date: Supervisor: Arch. Kigara Kamweru Date: Year Master: Prof. Tom Anyamba Date: Chairman: Arch. Musau Kimeu Date: III

5 Mama, because I have been, I am, and I forever shall be, your son. IV

6 ACKNOWLEDGEMENTS Because the fruition of this extension of my heart and soul was not possible without the following: My Family Mother: This piece is your son s contribution to your fight against Cancer. Even in your unpredicted absence, your guiding hand has never left me, and the urge to make you proud will never leave me. I ll see you one sweet day mama. Father: Because in her absence, you have been mother, father and friend. To have the ability to call myself your son has been an honour. Vera: One of the reasons why I believe angels exist in this lifetime. I have not now, nor have I ever seen a force so great. Betty: The other reason I believe that God created angels and let me call them my sisters. You are my light. My Second Family Connie, Kevin, Chematia, Khadija, Mark, Justus, Charles, Manda, Kibiro and Kenani: The family that destiny led me to. You continue to inspire me to surpass the best that I believed I could be. The School of Architecture Architect Kigara Kamweru: For taking the time to push me to realise the materiality of this Thesis. Prof. Tom Anyamba, Architect Musau Kimeu and the entire staff in the Architectural Department: For providing the unsolicited guidance that led to this achievement throughout my 6 years in the course. Cancer Care Kenya Mr. Chiman Shah of Cancer Care Kenya: The kindness and pure heartedness during the fieldwork won t be forgotten The Entire Architecture Class of 2016 It has been quite a journey full of all sorts of experiences. I m humbled to say that I have worked alongside such great minds. And last but not least to God. For the strength it took to dive into a topic that hit too close to home...

7 TABLE OF CONTENTS I 1.0 Introduction 1.1 Preamble 1.2 Background Study 1.3 Problem Statement 1.4 Research Questions 1.5 Research Objectives 1.6 Justification of Study 1.7 Scope and Limitations 1.8 Significance of Study 1.9 Organization of Study Literature Review Introduction Progression of Healthcare Facility Design The hospital of the future Lessons learnt from history 2.3 The User in the Oncological Institute 2.4 User Experience The Patient The Staff The Visitor Introduction Architect and Researcher Roger S. Ulrich Henning Larsen Array Architects C.F. Moller 2.5 Summary of Findings VI

8 TABLE OF CONTENTS II 3.0 Research Methodology Introduction Research Purpose Research Strategy Time Horizon Population, Element and Population Frame Sampling Method Data Data Analysis and Presentation Introduction Case Study Choice Access to Nature Provision of Control Lighting 4.6 Way-finding Positive Distraction Cancer Care Kenya Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre VII

9 TABLE OF CONTENTS III 4.0 Data Analysis and Presentation 4.8 Respite 4.9 Interior Design Local Case - Cancer Care Kenya International Case - Tata Medical Centre Local Case - Cancer Care Kenya International Case - Tata Medical Centre Comparative Analysis Parameter Summary Conclusions and Recommendations 5.1 Introduction Summary of Findings Recommendations 112 A. References A.1 List of References 106 B. Appendices POF 001 Nature Questionnaire XIV POF 002 Control Questionnaire XV POF 003 Lighting Questionnaire XVI POF 004 Way-finding Questionnaire XVII POF 005 Distraction Questionnaire XVIII POF 006 Respite Questionnaire XIX POF 007 Interior Design Questionnaire XX VIII

10 LIST OF FIGURES I Chapter I Fig. 1.01: Infographic illustrating the importance of user experience in a healthcare facility pg. 02 Fig. 1.02: Day shot capturing use of atrium lighting by Nick Guttridge pg. 03 Fig. 1.03: Infographic illustrating Cynthia McCullough s 5 principles of healthcare facility design pg. 04 Fig. 1.04: Infographic illustrating Array Architects healthcare facility design principles pg. 05 Fig. 1.05: Infographic illustrating the study s research questions and objectives pg. 06 Fig. 1.06: Infographic illustrating the author s projected scope of limitations pg. 07 Fig. 1.07: Infographic illustrating author s projected study organisation pg. 08 Chapter II Fig. 2.01: Daytime shot of Akershus University Hospital Thoroughfare, Norway(2014), by C.F. Moller Architects pg. 10 Fig. 2.02: Daytime shot of Vestfold Hospital s atrium, Norway(2005) by C.F. Moller Architects pg. 11 Fig. 2.03: Representative sketch of Casa Grande, 1450 i.e. an aesthetic hospital pg. 12 Fig. 2.04: Representative sketch of Bispebjerg Hospital, 1913, i.e. the hygienic hospital pg. 12 Fig. 2.05: Representative sketch of Copenhagen University Hospital, 1970, i.e. the recovery machine pg. 13 Fig. 2.06: Representative sketch of the patient hospital pg. 13 Fig. 2.07: Infographic illustrating Maria Larrain s healing environment breakdown pg. 14 Fig. 2.08: Infographic illustrating Ulrich s structure for the patient s needs pg. 15 Fig. 2.09: Infographic illustrating Ulrich s structure for the staff s needs pg. 16 Fig. 2.10: Infographic illustrating Ulrich s structure for the visitor s needs pg. 17 Chapter II Fig. 2.11: Infographic summary of Ulrich s system of needs Fig. 2.12: Infographic illustrating effects of poor design as denoted by Roger S. Ulrich pg. 18 Fig. 2.13: Infographic illustrating stress inducers according to Roger S. Ulrich pg. 19 Fig. 2.14: Infographic illustrating Ulrich s 3 healthcare design strategies pg. 20 Fig. 2.15: Infographic illustrating Ulrich s architectural interventions for provision of control pg. 21 Fig. 2.16: Infographic illustrating Ulrich s architectural interventions for provision of social support pg. 22 Fig. 2.17: Infographic illustrating Ulrich s architectural interventions for provision of positive distractions pg. 23 Fig. 2.18: Proposed Odense University Hospital by Henning Larsen Architects pg. 24 Fig. 2.19: Illustration of proposed Odense University Hospital by Henning Larsen architects showing design as a city pg. 25 Fig. 2.20: Representative drawings of proposed Odense University Hospital, Denmark, by Henning Larsen as a city pg. 25 Fig. 2.21: Illustration of the proposed Odense University Hospital entrance by Henning Larsen Architects pg. 26 Fig. 2.22: Illustration of the proposed Odense University Hospital showing the landscaped city pg. 26 Fig. 2.23: Illustration of the proposed Odense University Hospital showing the big house pg. 27 Fig. 2.24: Illustrative model of hospital within the city concept by Henning Larsen pg. 27 Fig. 2.25: DNR Radiation Therapy Unit, Denmark, by Henning Larsen Architects pg. 28 Fig. 2.26: Evening shot of Seidman Cancer Centre, USA, by Array Architects pg. 29 Fig. 2.27: Infographic illustrating need for symbiosis pg. 30 Fig. 2.28: Infographic illustrating Array Architects healthcare facility design principles pg. 31 Fig. 2.29: Montefiore Medical Centre by Array architects pg. 32 Chapter II Fig. 2.30: Zucker Hillside Hospital by Array architects pg. 33 Fig. 2.31: Representative diagram illustrating C.F. Moller s 9 principles governing user experience pg. 34 Fig. 2.32: Hospice Djursland, New Zealand(2011) by C.F. Moller architects pg. 35 Fig. 2.33: Daytime shot of Akershus University Hospital thoroughfare, Norway(2014), by C.F. Moller architects pg. 36 Fig. 2.34: Author-generated table illustrating summary of factors governing user experience according to Ulrich, Henning Larsen, C.F. Moller and Array architects pg. 37 Fig. 2.35: Author-generated table illustrating particular architectural response to the 7 guiding parameters of user experience pg. 38 Chapter III Fig. 3.01: Infographic illustrating Cynthia McCullough s 5 principles of healthcare facility design pg. 40 Fig. 3.02: Daytime shot of Cancer Care Kenya s main entrance pg. 41 Fig. 3.03: Daytime shot of Tata Medical Centre main pg. 41 Fig. 3.04: Infographic illustrating the author s research strategy pg. 42 Fig. 3.05: Infographic illustrating the author s population, element, and population frame pg. 43 Fig. 3.06: Infographic illustrating the author s chosen means of Data Collection pg. 43 Fig. 3.06: Infographic illustrating the author s chosen means of Data Presentation pg. 43 IX

11 LIST OF FIGURES II Chapter IV Fig. 4.01: Infographic illustrating the 7 parameters that will guide the 4th chapter of this study pg. 47 Fig. 4.02: Image showing the chosen local case, Cancer Care Kenya pg. 48 Fig. 4.03: Image showing the chosen international case, Tata Medical Centre pg. 48 Fig. 4.04: Daytime shot of Cancer Care Kenya s main entrance pg. 49 Fig. 4.05: Daytime shot of Tata Medical Centre pg. 50 Fig. 4.06: Infographic illustrating architectural criteria governing access to nature pg. 51 Fig. 4.07: Daytime shot of Cancer Care Kenya s Central interior garden pg. 52 Fig. 4.08: Daytime shot of Cancer Care Kenya s Central interior garden pg. 52 Fig. 4.09: Daytime shot of Cancer Care Kenya s Central interior garden pg. 52 Fig. 4.10: Author-generated representation of CCK ground floor pg. 53 Fig. 4.11: Author-generated representation of CCK ground floor pg. 54 Fig. 4.12: Image illustrating the inward view from the offices around the atrium pg. 55 Fig. 4.13: Image illustrating the view from the pedestrian walkway coming from M.P. Shah hospital pg.55 Fig. 4.14: Image illustrating the view from the outdoor terrace on the first floor pg. 55 Fig. 4.15: Image illustrating the view as one approaches the ambulance entrance pg. 55 Fig. 4.16: Image illustrating the gardens fronting the main circulation shaft pg. 56 Fig. 4.17: Image illustrating the view from the seminar room on the first floor pg. 56 Fig. 4.18: Image illustrating the view of the visitors an patients in the front reception s waiting area pg. 56 Fig. 4.19: Image illustrating the central garden pg. 57 Fig. 4.20: Image illustrating the visitors view from area 1 of the front reception pg. 57 Chapter IV Fig. 4.21: Image illustrating the visitors view from area 2 of the front reception pg. 57 Fig. 4.22: Daytime shot of Tata Medical Centre central courtyard pg. 58 Fig. 4.23: Representative drawing of Tata Medical Centre s site plan pg. 59 Fig. 4.24: Image illustrating wards facing courtyard pg. 60 Fig. 4.25: Image illustrating the provision of indirect access to nature via transparency pg. 60 Fig. 4.26: Image illustrating the view from the arrival hall pg. 60 Fig. 4.27: Infographic illustrating architectural criteria governing provision of control pg. 61 Fig. 4.28: Image illustrating noise curbing measures in the reception pg. 62 Fig. 4.29: Representative drawing illustrating spatial disposition for noise curbing on the CCK ground floor pg. 62 Fig. 4.30: Image illustrating the reception desk placement at the main entrance pg. 63 Fig. 4.31: Image illustrating signage on the first floor corridor pg. 63 Fig. 4.32: Image showing placement of artwork in the corridor fronting the radiotherapy unit for way-finding pg. 63 Fig. 4.33: Image illustrating change in the reception s floor material to further guide the users through the facility pg. 63 Fig. 4.34: Graphical representation illustrating how spatial disposition attains privacy in Cancer Care Kenya pg. 64 Fig. 4.35: Graphical representation illustrating how spatial disposition of the Chemo-Unit attains privacy pg. 65 Fig. 4.36: Image illustrating the user s view upon entry of the Chemotherapy Unit pg. 65 Fig. 4.37: Image illustrating privacy measures for the chair infusion bays pg. 65 Fig. 4.38: Image illustrating privacy measures for the bed infusion bays pg. 65 Fig. 4.39: Image showing use of operable windows and A.C in the chemo unit pg. 66 Fig. 4.40: Image showing use of A.C in the clinics pg. 66 Fig. 4.41: Image showing lack of operable windows in clinics pg. 66 Chapter IV Fig. 4.42: Image showing lack of operable windows in clinics pg. 66 Fig. 4.43: Representative drawing highlighting the staff break area pg. 67 Fig. 4.44: Representative drawing highlighting the outdoor terrace pg. 67 Fig. 4.45: Image showing the condition of the staff break area on the ground floor pg. 67 Fig. 4.46: Image showing the outdoor terrace on the first floor where staff, visitors and patients can interact pg. 67 Fig. 4.47: Tata Medical Centre site plan and elevation illustrating control measures pg. 68 Fig. 4.48: Image illustrating semi-privacy in wards via provision of opaque curtains pg. 69 Fig. 4.49: Image illustrating public waiting room with areas provided to accommodate patient beds pg. 69 Fig. 4.50: Infographic illustrating architectural criteria governing lighting strategy pg. 70 Fig. 4.51: Infographic illustrating the factors governing interior artificial lighting pg. 71 Fig. 4.52: Image showing the glazing on the north western facade pg. 72 Fig. 4.53: Image showing low height partitioning in the reception pg. 72 Fig. 4.54: Image showing the view from bed infusion bays 3 and 4 pg. 73 Fig. 4.55: Image showing the view from bed infusion bays 1 and 2 pg. 73 Fig. 4.56: Image showing the view from the entrance to the chemo unit pg. 73 Fig. 4.57: Image illustrating skylight in corridor leading to the chemo unit and support centre pg. 74 Fig. 4.58: Image showing the view of the dome from the staircase on the ground floor pg. 74 Fig. 4.59: Image illustrating the effect achieved via use of the perforated dome pg. 74 Fig. 4.60: Image showing the atrium s reflective properties pg. 75 Fig. 4.61: Image showing lack of proper reflective properties in the multipurpose room pg. 75 Fig. 4.62: Image showing reflectance properties in the chemo unit pg. 75 Fig. 4.63: Image showing reflectance properties in the corridor fronting the chemotherapy unit pg. 75 X

12 LIST OF FIGURES III Chapter IV Fig. 4.64: Representative drawing highlighting reception location pg. 76 Fig. 4.65: Image illustrating partitioning of the front reception pg. 76 Fig. 4.66: Image illustrating the use of partitions to avoid direct light from the atrium pg. 76 Fig. 4.67: Image illustrating the use of partitions to avoid direct light from the atrium pg. 76 Fig. 4.68: Image illustrating the use of blinds in the support centre pg. 77 Fig. 4.69: Image illustrating the use of blinds in the seminar room pg. 77 Fig. 4.70: Image illustrating the use of vegetative cover as a filter for undesired light pg. 77 Fig. 4.71: Image illustrating the use of vegetative cover as a filter for undesired light pg. 77 Fig. 4.72: Representative diagram showing building orientation pg. 78 Fig. 4.73: Image showing additional sun-shading measures on the western facade pg. 78 Fig. 4.74: Image showing artificial lighting in the corridor on the ground floor pg. 79 Fig. 4.75: Image showing artificial lighting in the corridor on the ground floor pg. 79 Fig. 4.76: Image showing artificial lighting in the rear reception on the ground floor pg. 79 Fig. 4.77: Image illustrating use of the perforated wall as a filtering strategy pg. 80 Fig. 4.78: Image illustrating reflectivity of the walls and ceilings in the main reception pg. 80 Fig. 4.79: Image illustrating use of balconies and large glass façades fronting the central courtyard pg. 80 Fig. 4.80: Image showing placement of the reception desk pg. 81 Fig. 4.81: Image illustrating courtyard use pg. 81 Fig. 4.82: Image illustrating courtyard use pg. 81 Fig. 4.83: Layout plan illustrating prevailing wind direction pg. 82 Fig. 4.84: Image illustrating courtyard use for ventilation pg. 82 Fig. 4.85: Image illustrating jali double wall system pg. 82 Fig. 4.86: Image illustrating deeply recessed windows pg. 82 Fig. 4.87: Image illustrating artificial lighting in the arrival hall pg. 83 Chapter IV Fig. 4.88: Image illustrating artificial lighting in a patient s room pg. 83 Fig. 4.89: Image illustrating artificial lighting in the ward corridors pg. 83 Fig. 4.90: Image illustrating artificial lighting in the circulation shaft pg. 83 Fig. 4.91: Infographic illustrating architectural criteria governing wayfinding strategy pg. 84 Fig. 4.92: Image illustrating signage on the first floor corridor of CCK pg. 84 Fig. 4.93: Image showing material interchange at reception I pg. 85 Fig. 4.94: Image showing material interchange at reception II pg. 85 Fig. 4.95: Image showing the central garden pg. 85 Fig. 4.96: Image showing artwork along the radiotherapy corridor pg. 85 Fig. 4.97: Image showing artwork in the rear reception pg. 85 Fig. 4.98: Representative drawing illustrating layout of the ground floor pg. 86 Fig. 4.99: Representative drawing illustrating layout of the first floor pg. 86 Fig : Sectional diagram illustrating vertical functional disposition in Cancer Care Kenya pg. 86 Fig : Image illustrating signage in the paediatric ward pg. 87 Fig : Image illustrating campus approach to functional disposition pg. 87 Fig : Section illustrating campus approach to functional disposition pg. 87 Fig : Representative drawing illustrating Canon Design s campus approach to functional disposition pg. 88 Fig : Image illustrating exterior wall material change pg. 89 Fig : Image illustrating materiality interplay in the wards pg. 89 Fig : Image illustrating courtyard use to create a point of visual interest pg. 89 Fig : Image illustrating use of art in the waiting areas pg. 89 Fig : Images illustrating incorporation of positive distractions in Cancer Care Kenya pg. 90 Fig : Image illustrating use of art as a distraction in Tata Medical Centre pg. 91 Fig : Image illustrating use of televisions as distraction pg. 91 Chapter IV Fig : Image illustrating use of nature at the main entrance as distraction pg. 91 Fig : Image illustrating Faraja Support Centre pg. 92 Fig : Image illustrating terrace outside the support centre pg. 92 Fig : Image showing a mini-library in the support centre pg. 92 Fig : Image showing a sample massage room in the support centre pg. 92 Fig : Image showing the fitness centre pg. 92 Fig : Image illustrating waiting areas as respite pg. 93 Fig : Image illustrating courtyard use for respite pg. 93 Fig : Image illustrating courtyard use for respite pg. 93 Fig : Image illustrating materiality and furniture selection in the receptions in Cancer Care Kenya pg. 94 Fig : Image illustrating materiality and furniture selection in the receptions at Cancer Care Kenya pg. 94 Fig : Image illustrating materiality and furniture selection in the chemo unit at Cancer Care Kenya pg. 95 Fig : Image illustrating materiality and furniture selection in the seminar room at Cancer Care Kenya pg. 95 Fig : Image illustrating materiality and furniture selection in the support centre at Cancer Care Kenya pg. 95 Fig : Image illustrating materiality and furniture selection in the arrival hall s reception and waiting area at Tata Medical Centre pg. 96 Fig : Image illustrating materiality and furniture selection in the ward waiting area pg. 96 Fig : Image illustrating a close-up of materiality and furniture selection in the ward pg. 97 Fig : Image illustrating a close-up of materiality and furniture selection in the ward and its circulation space pg. 97 XI

13 LIST OF FIGURES IV Chapter V Fig. 5.01: Infographic illustrating the importance of user experience in a healthcare facility pg. 106 Fig. 5.02: Infographic illustrating the 7 parameters that guided the 4th chapter of this study pg. 107 Fig. 5.03: Daytime shot of Cancer Care Kenya s main entrance pg. 108 Fig. 5.04: Daytime shot of Tata Medical Centre s main entrance pg. 108 Fig. 5.05: Images comparing access to nature in both cases pg. 109 Fig. 5.06: Plan drawings comparing provision of control in both cases pg. 109 Fig. 5.07: Images comparing lighting strategies in both cases pg. 110 Fig. 5.08: Images comparing way-finding in both cases pg. 110 Fig. 5.09: Images comparing positive distraction and respite in both cases pg. 111 Fig. 5.10: Image comparing interior design strategies in both cases pg. 111 Fig. 5.11: Infographic illustrating recommendations for the study pg. 112 XII

14 ABSTRACT Patient Experience in Oncological Facilities As times have progressed, architectural design has dissipated into 3 basic entities i.e. Function, Aesthetics and Experience. The third aspect is the main focus of this study, whereby the targeted space is the oncology facility and the primary user of said space is the patient. According to Maggie Keswick Jones (a Cancer patient and pioneer of Maggie s centres worldwide), architecture is indeed capable of demoralizing patients. However, it simultaneously has the ability to prove restorative. Roger S. Ulrich postulates that a person receiving medical treatment requires 2 basic needs to be addressed i.e. the physiological need (treatment of the disease) and the psychological need (treatment of the emotional and mental state that accompanies diagnosis, treatment and aftercare). This remains true for cancer patients as well. This study therefore seeks to establish exactly how the architectural design of an oncology facility can be used to positively influence patient experience and subsequently staff and visitor experience as well. The findings of Roger Ulrich, Array, Henning Larsen and C.F. Moller architects put forth 7 parameters that govern overall experience in healthcare facilities. Those are access to nature, provision of control, lighting, way-finding, positive distraction, respite and interior design. This study outlines the findings from 2 particular cases. The criteria that governed the case choice was based on the need to illustrate what is happening in developed countries versus what is happening locally with regard to the architectural design of Cancer treatment facilities. The international case chosen was Tata Medical Centre in Kolkata, India. This acted as the benchmark under which the local case was then compared. The local case chosen was Cancer Care Kenya in Parklands, Nairobi. The case studies were broken down into the 7 factors under which each was critically examined i.e nature, control, light, way-finding, distraction, respite and interior design. The success or lack thereof of the architectural responses to each factor was then very closely investigated and documented. The findings show that before the design of a treatment facility of this nature takes place, it is imperative to first understand the intended user s needs i.e. the patient, the staff and the visitor. They also reveal that architectural design can indeed create an environment that can be said to have a healing nature for all its users. However, this can only be achieved if the 7 parameters mentioned above are addressed adequately. It was also noted that the parameters do not act as singular entities. Rather, they work symbiotically to achieve the common goal i.e a positive user experience for the patient, their visitors and the staff e.g. via providing a central courtyard to provide access to nature, control and way-finding are also provided as the courtyard serves as an organizing principle. Again, natural lighting, a positive distraction and a place of respite can all be created via the incorporation of the same courtyard. Last but not least, the findings indicated that the patient s experience is also tied to the staff and visitor experience. Via a balanced and carefully calculated incorporation of the 7 parameters, the psychological needs of the patient, their visitors and the staff begin to receive the appropriate level of attention. This then leads to reduced recovery times for patients, which achieves the main goal i.e. wholesome treatment.

15 Introduction

16 Patient Experience in Oncological Facilities - Introduction Introduction: The User in any Architectural space is the person or persons for which a given space is intended. The term Experience refers to how one feels when they enter, leave or inhabit a particular space for a specific amount of time. Fusing both terms together, results in a phenomenon known as User Experience. According to Flemming, 1998, from a broader perspective, user experience can be defined as a person s behaviours, attitudes and emotions about using a particular product, system or service. The product in use here is essentially architectural space, which in this specific case is the healthcare facility i.e. the oncological institute. Healthcare is the prevention, treatment and management of illness and preservation of mental and physical well-being through the services offered by the medical and allied health professions (World Health Organization, 2013). Based on a process known as Evidence Based Design (employing solutions obtained from previously established successful strategies), studies have proven that the built form has a big impact on the user of any space. This is especially true with regard to the healthcare facilities, where there is need to address two (2) types of needs: +Physiological +Psychological >Fig 1.01 INFOGRAPHIC ILLUSTRATING THE IMPORTANCE OF USER EXPERIENCE IN A HEALTHCARE FACILITY In the design of any architectural space, it is imperative to engage the user in what can be termed as the third level i.e. the perception of space. This can only be achieved via the creation of an all-rounded experience which is in turn a result of meeting all the user s needs. Source: Author generated on Aug 18th at 2344h Healthcare facilities can be broken down into the following: +Hospitals, +Healthcare centres, +Nursing homes, +Pharmacies and drug stores, +Laboratories and research facilities The study therefore will focus on how user experience is achieved in the design of a variety of the above types, with its main focus being on the Oncology Institute.

17 Patient Experience in Oncological Facilities - Introduction Background Study: The establishment of treatment has evolved greatly with time. This has led to many ground- breaking innovations especially in the technology applied to the administration of treatment. This has led to a need for revision of what was, or still is, in consideration as a viable or efficient solution to accommodate these changes. Using Nairobi as a case study, the major hospitals were first designed with a focus on functional efficiency. This is a methodology referred to as Function-Driven design; meaning these hospitals were designed with view of treating the physiological needs of the patient i.e. the treatment of the actual ailment. With time, a paradigm shift has occurred, with more emphasis being placed on designing for the user rather than the function. Therefore, the design can be said to be human-centred. As discussed earlier, the user is the person(s for which spatial design is intended. Going by this, we establish that the user in the Oncology facility is: + The Patient + The Staff + The Patient s visitors i.e. family, friends & other visitors >Fig 1.02 DAY SHOT CAPTURING USE OF ATRIUM LIGHTING BY NICK GUTTRIDGE In one of Nick Guttridge s architectural photography pieces, he illustrates how powerfully the interplay of natural light and materiality can contribute to a positive user experience. Source: Image sourced from on Sep 9th at 2250h, further edited by author Diagnoses can be emotionally destabilizing for any user, especially the patient. Based on the above, it begins to become apparent that the individual needs of each type of user will vary. The patient wants to be treated and to heal in the best of conditions possible. The staff want to establish efficient treatment to the patient, also in the best environment possible. The next of kin and other visitors want to ensure that their patient s treatment and healing process is going on in the best possible way, in the best environment and in the best hands, while they themselves are reassured that all will be well. It is therefore imperative that the built form and its surroundings respond to all these needs in the most user-centred manner.

18 Patient Experience in Oncological Facilities - Introduction 4 Some of life s most poignant moments from childhood to a Cancer diagnosis occur in the spaces we design. Ultimately, these spaces are about people, comfort and supporting them in a quiet and beautiful way. Laura Morris 1.3 Problem Statement: With reference to Oncology Healthcare Institution design, what exists locally, for example Kenyatta National Hospital and Aga Khan Hospital, have been designed with more emphasis on addressing one of the patient s needs; the physiological need i.e the treatment of the actual disease. What this suggests is that the psychological need of the patient and the needs of the other users already discussed, have been neglected. Cynthia McCullough s findings in her book Evidence Based Design for Healthcare Facilities state that the following are the factors to be taken into consideration when designing for the user in the healthcare facility: 1. Air quality, 2. Thermal comfort, 3. Noise control, 4. Privacy & >Fig 1.03 INFOGRAPHIC ILLUSTRATING CYNTHIA MCCULLOUGH S 5 PRINCIPLES OF HEALTHCARE FACILITY DESIGN According to McCullough, 2009, the factors that require critical attention in Healthcare facility design are air quality, thermal comfort, noise control, privacy & light Source: Author-generated on Aug 18th at 0005h 5. Light These findings allude to the fact that a good user experience for all the users of the facility can be achieved via overall sustainable design.

19 Patient Experience in Oncological Facilities - Introduction 5 Array Architects, an architecture firm based in the United States focused mainly on Healthcare Institute design,begin to dispute this approach. They state that for a good user experience to be attained both internally and externally, the factors that require critical focus are the following: + Introduction of natural aspects to the design i.e. light, air and water + Provision of positive distractions at critical points in the design,for example, artwork in the entrance lobbies and waiting areas + Provision of proper way-finding strategies + Giving the patient more control over their surroundings, for example, more than choice of only privacy level + Materiality that creates the desired ambience >Fig 1.04 INFOGRAPHIC ILLUSTRATING THE ARRAY ARCHITECT S HEALTHCARE FACILITY DESIGN PRINCIPLES Though they share a few similarities with McCullough s approach, Array Architects are governed by their own principles i.e. natural aspects, positive distractions, wayfinding strategies, control, materiality, furniture & respite Source: Author-generated on Aug 19th at 0011h + Furniture selection + Introduction of places for respite for example healing gardens This study therefore seeks to establish if these and other factors exist in any form in the local case studies, to show how they have been used elsewhere and to show how the lessons learnt can be incorporated locally to provide the desired user experience in a healthcare institute.

20 Patient Experience in Oncological Facilities - Introduction Research Questions: The questions that will be used as a guideline for the entire study are as follows: + Who is the user in the Oncology Healthcare Facility and what are their user-specific needs? + What is user experience and what importance does it serve the Oncology Healthcare facility? + How can the built form, in this case the Oncology Healthcare Institute and its surroundings, impact the user experience? + Which factors contribute to a positive user experience and which ones detract from it? 1.5 Research Objectives: The aims and objectives of the study are as documented below: + To establish who the user in the Oncology healthcare facility is and to understand each of their needs + To demonstrate what is meant by the term User Experience and what importance it serves said Oncology healthcare facility + To establish how the built form, specifically Oncology healthcare facilities, impacts on User Experience + To illustrate the factors that contribute to a positive user experience, those that detract from it, and why >Fig 1.05 INFOGRAPHIC ILLUSTRATING THE STUDY S RESEARCH QUESTIONS & OBJECTIVES The research questions and objectives of the study shall be undertaken in a quadruple fashion namely understanding the user, user experience, the impact of built form on the latter and factors influencing overall user experience. Source: Author-generated on Aug 19th at 0552h 1.6 Justification of Study: There has been a paradigm shift with regard to the design of architectural space as time has advanced. In recent times, designers have begun to focus more on meeting the aesthetic and functional needs of their clients. What this leads to is beautiful buildings with adequate functionality which neglect to fully engage the user in the design. This could be described as the third level of design, with the first two being: + Functionality + Aesthetic value The third level is hence the User Experience and its inclusion in the design process has been proven to lead to a more wholesome final product especially in the design of healthcare facilities. This study therefore seeks to establish exactly how User Experience in the afore-mentioned facility can be achieved successfully.

21 Patient Experience in Oncological Facilities - Introduction 7 Measurement of feeling 1.7 Scope & Limitations: The study will begin with documentation of desk studies showing what is considered successful in terms of user experience in Healthcare Facility design. The measurement of success will be based on the principles of Evidence Based Design. This will show why they are considered successful at a very detailed level. The study will then shift its focus to case studies namely M.P. Shah s Cancer Care Kenya locally and Tata Medical Centre internationally. These shall be analysed against the principles that govern user experience as outlined by Array Architects and others. A comparison of all the data collected will begin to illustrate what needs to be done in the future. >Fig 1.06 INFOGRAPHIC ILLUSTRATING THE AUTHOR S PROJECTED SCOPE OF LIMITATIONS Perception is an abstract concept. Its measurement therefore depends entirely on subjective opinions, which begins to introduce unwarranted bias to the study. This will require the author to find alternative means of measurement. Time allocated Resources available Source: Author-generated on Sep 17th at 1030h The limitations of the study are as follows: + Since how one feels is abstract, measurement cannot be quantified as it depends on an individual s perception of space. This therefore means that conduction of various research methods for example interviews may begin to introduce bias to the study. + The time allocated for the study may not be sufficient for a detailed and in-depth documentation of Healthcare facilities both locally and internationally + Resources available will not allow for conduction of thorough research, especially where trips need to be conducted frequently, for example trips abroad to observe how user experience is tackled in various healthcare facilities. 1.8 Significance of Study: This study will illustrate the principles of design that lead to a positive user experience. This cannot be constrained to the design of healthcare facilities alone. How the intended user perceives the space is just as important as how well the building functions or its aesthetic quality. By illustrating how a positive user experience can be attained, this knowledge can hence be used to inform other types of institutional designs. This document may then serve as a prototype or a baseline for the achievement of successful user experience in any architectural space in the future.

22 Patient Experience in Oncological Facilities - Introduction Introduction Literature Review Research Methodology Data Analysis & Presentation Conclusion & Recommendation 1.9 Organization of Study: Chapter I of this study gives a brief introductory background to Healthcare, Oncology, the user in the afore- mentioned and user experience in the same in order to give the reader a better grounding as to what exactly the author intends to research on. Chapter II consists of the review of both published and unpublished works on the topic of study. It examines who the user in the Oncology facility is, what exactly is meant by the term user experience, and the factors that pertain to its acquisition in the healthcare facility. This is achieved via studying the works of authors of different times in order to give a more informed understanding as to how design for the user in the health facility was done in the past, and how it is done today. The authors focused on are Architect & Researcher Roger S. Ulrich, Array Architects, Henning Larsen Architects & C. F Moller Architects. The parameters obtained from this chapter will hence govern the 4th chapter study as it will entail documenting the presence or lack thereof of said parameters. Chapter III delineates the techniques that will be used in the conduction of this research. It also indicates the methods of data collection, analysis and presentation that shall be utilised in order to further deepen the understanding of the topic of study. >Fig 1.07 INFOGRAPHIC ILLUSTRATING AUTHOR S STUDY ORGANISATION The study will be broken down into 5 separate chapters as is illustrated and colour coded above. This will hence enhance the reader s further understanding. Source: Author-generated on Sep 17th at 1049h Chapter IV of this study entails the critical analysis of the chosen case studies i.e. Cancer Care Kenya and Tata Medical Centre. It is however important to note that the case studies selected will not be studied in their entirety. Rather, the specific point of focus will be their response to cancer treatment. This shall then be corresponded with the parameters outlined in Chapter II of this study. Chapter V will then give the lessons learnt from the case studies and how they can be utilised, or added onto, in order to give the best way forward with regard to Patient Experience in Oncology Institutes.